Excess Androgens, Congenital Disorders and Male Hypogonadism

Question 1

What is hirsutism?

Answer 1

Excess hair in a male pattern, in a woman

Question 2

What causes hirsutism?

Answer 2

Excess androgens at the hair follicle

Question 3

Give 4 causes of hirsutism which present with a long history, fairly normal testosterone and no virilisation?

Answer 3

PCOS, familial, idiopathic, non-classical CAH

Question 4

How does hirsutism as a result of an adrenal or ovarian tumour present?

Answer 4

Short history with virilisation

Question 5

What is non-classical CAH?

Answer 5

A partial 21 alpha hydroxylase deficiency which presents in adolescence

Question 6

How may non-classical CAH present?

Answer 6

Hirsutism, menstrual irregularity, infertility

Question 7

What treatment is used in non classical CAH?

Answer 7

Low dose corticosteroid

Question 8

What are the testosterone levels in an androgen secreting tumour?

Answer 8

High (>5)

Question 9

Which out of adrenal and ovarian androgen secreting tumours are more likely to be malignant?

Answer 9

Adrenal

Question 10

XO is what condition? Which sex does this affect?

Answer 10

Turner’s syndrome, only affects girls

Question 11

What are some features of Turner’s syndrome?

Answer 11

Short stature, webbed neck, wide spaced nipples, lymphedema, delayed puberty

Question 12

What should be screened for in an individual with Turner’s syndrome?

Answer 12

Cardiac and renal problems, IBD, osteoporosis and scoliosis

Question 13

What cardiac problems may Turner’s cause?

Answer 13

Coarctation of the aorta, bicuspid aortic valve, hypo plastic left heart

Question 14

What is XX gonadal dysgenesis?

Answer 14

Absent ovaries but no chromosomal abnormalities

Question 15

What is testicular feminisation?

Answer 15

Androgen insensitivity syndrome: genetically XY but phenotypically female

Question 16

When is a hysteroscopy performed?

Answer 16

Only in cases where there is suspected or known endometrial pathology

Question 17

What is the main investigation for pelvic disease?

Answer 17

Pelvic ultrasound

Question 18

What are the levels of testosterone and LH/FSH in primary hypogonadism?

Answer 18

Testosterone- low, LH/FSH- high

Question 19

What is the most common congenital form of hypogonadism in males?

Answer 19

Kleinfelter’s syndrome

Question 20

What is the chromosomal abnormality in Kleinfelter’s syndrome?

Answer 20

XXY

Question 21

What are some symptoms of Kleinfelter’s syndrome?

Answer 21

Decreased testicular volume, gynaecomastia, intellectual dysfunction, azoospermia

Question 22

Are people with Kleinfelter’s syndrome fertile?

Answer 22

No

Question 23

In Kleinfelter’s syndrome, what are the levels of testosterone, LH/FSH, SHBG, oestrogen?

Answer 23

Testosterone- low, everything else high

Question 24

What are the levels of testosterone and LH/FSH in secondary hypogonadism?

Answer 24

Testosterone- low, LH/FSH- inappropriately low

Question 25

What is the main cause of secondary hypogonadism in males?

Answer 25

Hypothalamic/pituitary disease

Question 26

What are some congenital/acquired causes of secondary hypogonadism in males?

Answer 26

IHH, Kallmann's, CAH

Question 27

When is testosterone replacement therapy used in hypogonadism?

Answer 27

In young men (< 50)

Question 28

Does testosterone cause prostate cancer?

Answer 28

No, but it can exacerbate it if it is already there

Question 29

Will testosterone therapy restore fertility?

Answer 29

No

Question 30

What may testosterone therapy help with?

Answer 30

Improved sexual function, bone health, body composition, insulin sensitivity, QOL and cognition

Question 31

Gynaecomastia is a result of an increase in what hormone?

Answer 31

Oestrogen

Question 32

What are some drugs which may cause gynaecomastia?

Answer 32

Oestrogen, testosteron, digoxin, spironolactone